When I saw that Colorado recently made it possible to get birth control without a doctor’s visit, I cheered.
Then I read the comments. To be honest, they were well-intentioned. People were worried that this would allow women to take birth control (and therefore take on its associated risks) without a medical pass. Who would tell them which kind to take? Who would tell them if it was okay for their bodies?
I think a lot of this discussion comes back to a misunderstanding of how birth control is prescribed. Perhaps critics believe that that there are major tests involved with approving and monitoring a woman for birth control. That our hormones are measured before choosing a particular brand, or that we are tested for blood clots or other side-effects when we renew our prescriptions. That doctors offer tests or medical insights that a properly trained pharmacist couldn’t replicate.
In my experience, that is far from the case. In fact, as a very mobile young woman without a steady family doctor, needing a prescription was an expensive, time-consuming, and sometimes health-threatening situation. Here’s my story.
I’m seventeen. I walk into my doctor’s office, alone. Two years ago, she whispered ‘just holler if you need the pill!’ in my ear and winked as my mother left the room. Today, I’m nervously cashing that cheque.
After checking my vitals, the trustworthy doc hands me a box of birth control pills. I ask why she chose that one. She answers frankly, “Because that’s the free sample I have lying around right now. You just kinda have to try one and see how your body reacts. Call me in three months if gives you problems.”
The pills have changed my life. Besides the usual suspects, the pills regulate I-can’t-function cramps. I happily throw out the massive painkillers I used to take, which I referred to as “horse pills.” It is a welcome change.
I’m leaving for University. My new school is in Ottawa, a six hour drive from my hometown. My doctor gives me a prescription for my birth control pills and sends me off. For the next year and a half, I get refills over the phone without incident.
My doctor retires. I don’t live in the same city, so I don’t qualify for the new doctor she’s sending patients to. At first, it doesn’t seem like a huge deal. I’m a healthy young person. I’ll figure it out later.
My birth control prescription runs out. I don’t have a family doctor. Shit. I need to start my new round tomorrow, and I am leaving for a 3-month work term in another country in a few days. Double shit.
With this tight timeline, the campus walk-in clinic is my only option.
I wait several hours to see a physician, who shakes his head at my request. He scolds me, saying that I am wasting his time. Something so “silly” should be done by appointment. I hang my head, agreeing that I should have planned better, and hastily take the prescription without answering a single medical question. It is enough for 3 months, leaving me less than two weeks after my return to Canada to figure out a refill.
I return from my trip and head straight to an appointment with a nurse practitioner in the campus clinic. She asks only one medical question: “Have you had a pap smear recently?”
I say that I had one about a year ago, and she writes a prescription for 28 days worth of pills. She tells me I need to have a pap before she will let me have any more. I ask if a pap smear has anything to do with birth control. She says no, but it’s motivation. She holds my medication – which I need for cramping – hostage until I get the elective exam.
One month later.
The campus clinic connects me with a new doctor so I can get the pap smear. He raises an eyebrow when I share my experience with the NP, proceeding to write me a 6-month prescription for birth control.
Like every doctor before him, he asks no real questions about my health before giving me the pills. There are no questions to ask, really. He knew I’d been taking them for years without side effects. What else could he need to know?
Six months later.
I am now working five jobs while going to school. I’m busy. More importantly, after so many awkward experiences with prescription refills, I’m gun-shy. I stop taking my pills. I have violent mood swings for weeks, but the cramps don’t come back. This works, I guess.
One night, I talk to a friend who has moved to a remote community in another province. She, too, has gone off the pills. She tells me she faced challenge after challenge with switching over to the new provincial health system, eventually running out of time to refill her prescription. Going off of the pills has risks for her, too, but she feels there are no other options.
Dropping the birth control makes me safe from awkwardness or judgement of doctors, but it also makes me feel vulnerable. What once sounded like a far-fetched statistic (as if 1 in 5 women are sexually assaulted!) becomes a reality I cannot avoid. Friends share stories of close calls and full-out violations. Women around me struggle with abusive boyfriends, party drugs, and date rape. I have my own uncomfortable incident.
I decide to get back on the pills. I realize they not only keep me from the monthly mood swings, but also safeguard me from a very unwanted pregnancy.
My stomach is giving me grief, so I regularly see a physician now. For once, I am able to get a prescription easily. I laugh to myself. It is easier to get birth control when I am sick and under medical supervision – a higher risk candidate, likely – than it was when as a healthy young person who didn’t have a doctor on speed dial.
I graduate University and move to yet another city. No local doctor once again. Every few months, I pay a fee to the clinic back in Ottawa to sign off on another supply of birth control pills. I never talk to the doctor when I have the prescription refilled. There is no reason to. We don’t even live in the same place.
Late December, 2016.
I am two days from embarking on a road trip in the United States. With 3 months left on my prescription, I run into the pharmacy between holiday commitments to stock up for the trip.
The pharmacist tells me my prescription is actually empty. Shit. I call Ottawa, but my doctor is on vacation and no one else is allowed to sign the prescription. Once again, a walk-in clinic is my only option.
The wait is 2 hours this time. I apologize profusely to the doctor. This time, he apologizes back. “I mean, these visits are easy money for me, but they’re a cash grab. I get paid by the appointment either way. You as a taxpayer gets to foot the bill.” I half-laugh while eyeing the clock, late for a family event. He takes pity on me and writes a prescription for one year’s supply of pills. It feels like a miracle.
The moral of the story.
“Hey, just check in with your doctor once a year, why not?” might sound harmless. But for women who don’t have a family doctor, that’s easier said than done. Ditto if your doctor retires, moves, or takes a sabbatical at an inopportune time. Or if you change locations, especially to a remote community and/or a new province.
Maybe you think it is irresponsible of me and other women to not plan ahead for these things. In my case, you would be right about that. I should have gotten a new doctor. I should have kept track of what I had left. But the fact is, the times I had the most trouble accessing birth control prescriptions were the times I was least stable and least prepared for a pregnancy. Women who are young, flustered, doctorless, or “irresponsible” should have more access to safe, effective birth control, not less.
For women like me, requiring a prescription for birth control is a major hoop to jump through, an appointment that has no medical purpose. A doctor never once asked a question besides “How long have you been on your brand?” and “Any issues with it?” before renewing my prescription. They took my blood pressure, but a pharmacist could do that easily. In fact, I learned quickly to direct any questions about birth control to pharmacists, who seemed to always have more insights into the medication.
Not only is this system a challenge for women without a steady address or doctor, it can also be expensive. My most recent doctor’s office charges $20 to rubber stamp a renewal. And that fee is nothin’ compared to the pretty penny the government pays every time I go into a clinic for a new piece of paper. This isn’t what an effective, fiscally responsible health care system looks like. This isn’t what caring about women’s health looks like.
(…now if you’ll excuse me, I just lost another family doctor because she moved. And I myself relocated to another new city a few months ago. Better go find a doctor before my prescription runs out. Again.)